LMR - Georgette's (GRADED A) Georgette's PMHNP Certification Exam TESTBANK, Exams of Nursing

Download LMR - Georgette's (GRADED A) Georgette's PMHNP Certification Exam TESTBANK and more Exams Nursing in PDF only on Docsity! LMR - Georgette's (GRADED A) Georgette's PMHNP Certification Exam TESTBANK What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? cultural assessment What is the normal range for TSH? 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? Mania What are 5 symptoms of Stephen's Johnson Syndrome? Fever Body aches Severe red rash Peeling skin Facial and tongue swelling Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of Stephen's Johnson Syndrome Which mood stabilizer causes the least weight gain? Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) What are 3 hallmark symptoms of delirium? Acute disturbance of LOC impaired cognition inattention Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of Delirium How are agitation and psychotic symptoms treated in delirium? Low dose Haldol What 4 drugs can cause mania? Steroids Disulfiram (Antabuse) Isoniazid (INH) Antidepressants (in BPD) Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce Mania What 6 drugs can induce depression? Steroids Beta blockers Interferon, Isotretinoin (Accutane) Retroviral drugs, Antineoplastic drugs Benzodiazepines Progesterone Steroids can induce what 3 psychiatric states? Mania Depression Psychosis What medication to treat acne cause cause birth defects? Isotretinoin (Accutane) What is the therapeutic range for lithium? 0.6-1.2 mEq/L What medication has a neuroprotective effect for bipolar disorder? Lithium Thiazides ACEI What is a toxic level of lithium? 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? 1.3 mEq/L or higher With suspected lithium toxicity, what do you do first? Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? DC lithium Check lithium level What 2 conditions can increase lithium levels? Dehydration Hyponatremia What birth defect can lithium cause? Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? DNS What 3 parts of the brain are affected with ADHD? Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? Cardiac history Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? 20 x 10 mg = 200 mg (q month) What is the formula for converting oral Haldol to depot form? 20 x daily dose What does thought process assess? thoughts and ideas The way a patient organizes his thoughts and ideas is called Thought process A normal thought process is described as Logical Linear Coherent Goal-oriented Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? Negative symptoms Depressive symptoms The nigrostriatal pathway modulates motor movements Dopamine has what type of relationship with acetycholine Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? Acute dystonia Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking the tuberoinfundibular pathway leads to Increased prolactin What are 5 symptoms of hyperprolactinemia? Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long-term) What antipsychotic has the greatest effect on prolactin? Risperidone What is the black box warning for carbamazepine? Agranulocytosis What are 8 symptoms of aplastic anemia? Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of Aplastic anemia What ethnic group is most susceptible to SJS with carbamazepine? Asians Having the HLA-B*1502 allele increases the risk for SJS Which ethic group is at most likely to have the HLA-B*1502 allele? Asians Asians are most likely to have what allele? HLA-B*1502 In which ethnic group must you screen for the HLA-B*1502 allele before initiating therapy? Asian Which 2 drugs have the highest likelihood of causing agranulocytosis? Clozaril Carbamazepine Family move Parent divorce/separation Loss of pet Birth of sibling Sudden or chronic illness A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? Not going to school, destroying property, driving recklessly, or fighting What is the required duration of behavior for a DSM-5 diagnosis of Oppositional Defiant Disorder (ODD)? 6 months How many symptoms must a child with Oppositional Defiant Disorder (ODD) display to meet DSM-5 criteria? 4 An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior is characteristic of Oppositional Defiant Disorder (ODD) What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? Therapy What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? Child and parent problem-solving skills training A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder? Conduct Disorder What are 3 characteristics of Conduct Disorder? Destruction of property Deceit or theft Lack of remorse What 2 factors differentiate Conduct Disorder from ODD? Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? Antipsychotics Mood stabilizers SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? Therapy What type of therapy is used in the treatment of Conduct Disorder? Behavioral therapy What is Multisystemic family therapy? Home-based model for youth with serious antisocial and criminal offenses by empowering parents with resources and skills and reducing barriers to resources needed for effective management of youth What is the goal of multisystemic family therapy (MFT)? Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? Multisystemic family therapy What is the moderate range for MMSE 10-20 moderate symptoms (15 or higher) If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDI), how do you treat it? Medication and/or therapy Assess for suicidal ideation If a patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI), how do you treat it? Medication and/or therapy If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat it? Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? Medication and/or therapy If a patient has moderate anxiety (18-24 on HAM-A) (10 - 14 on GAD-7) how do you treat it? Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? Prefrontal cortex Amygdala Basal ganglia Hippocampus Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytosis Elevated LFTs Extreme muscular rigidity, Mutism, Elevated CPK (creatine phosphokinase), Myoglobinuria, Leukocytosis, and Elevated LFTs are symptoms of NMS What are 2 symptoms of Serotonin Syndrome? Hyperreflexia Myoclonic jerks Hyperreflexia and myoclonic jerks are symptoms of Serotonin Syndrome How do you treat NMS? DC antipsychotic Bromocriptine or Dantrolene What does Dantrolene treat in NMS? Muscle rigidity How do you treat Serotonin Syndrome? DC Antidepressant Cyproheptadine The age criteria for a DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) is >6 and <18 (7-17 yrs.) A child who is chronically "moody" is most likely to have what diagnosis? DMDD What are 2 symptoms associated with lead poisoning? Developmental delay (learning difficulties) Pica (paint chips) also gastrointestinal Which 2 demographic characteristics are associated with lead poisoning? rural areas 1970's A child with developmental delay who eats things (such as paint chips) may have Lead poisoning What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain? BMI Hip-to-waist ratio Glucose Lipid panel Where is norepinephrine produced? Locus coeruleus Medullary reticular formation The neurotransmitter produced in the locus coeruleus and medullary reticular formation is Norepinephrine What neurotransmitter is produced in the raphe nuclei in the brainstem? Serotonin Serotonin is produced in raphe nuclei in the brainstem What neurotransmitter is produced in the substantia nigra, the ventral tegmental area (VTA), and the nucleus accumbens? Dopamine What 3 areas of the brain is dopamine produced? Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized? Basal nucleus of Meynert The Basal nucleus of Meynert is the area where what neurotransmitter is produced? Acetycholine What is the function of the amygdala? Emotions (aggression, fear, anxiety) Emotions (aggression, fear, and anxiety) originate from what area of the brain? Amygdala What are 4 functions of the hippocampus? Emotions Stress Antipsychotic (haloperidol, pimozide, aripiprazole*) What are the 3 primary neurotransmitters involved in Tourette's Disorder? DNS What are 11 risk factors for suicide? Previous suicide attempt 45 and older (55 for women) Divorced, single, or separated White (Caucasian) Living alone Psychiatric disorder Physical illness Substance abuse Family history of suicide Recent loss Male gender What age is a risk factor for suicide? 45 and older What gender is a risk factor for suicide? Male What race is a risk factor for suicide? White (Caucasian) What 4 demographic characteristics are risk factors for suicide? 45 and older Single White Male What are 5 physical characteristics of Anorexia Nervosa? Low BMI Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension Low BMI, Amenorrhea, Emaciation (abnormally thin), Bradycardia, and Hypotension are characteristics of what psychiatric disorder? Anorexia Nervosa What is the BMI in a patient with Bulimia Nervosa Normal range For a DSM-5 diagnosis of Acute Stress Disorder, what is the onset of symptoms? Within 4 weeks of traumatic event Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder? Acute Stress Disorder What are the 3 hallmark symptoms of PTSD? Intrusive re-experiencing Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSD SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD? EMDR What are 4 therapeutic factors in Yalom's Group Therapy? Instillation of hope Universality Group cohesiveness Altruism What is an approach to organizational change which focuses on strengths rather than weaknesses? Appreciative Inquiry What is appreciative inquiry? An approach to organizational change which focuses on strengths rather than weaknesses What are the 3 goals of Quality Improvement? Projects designed to improve systems, decrease cost, and improve productivity Projects designed to improve systems, decrease cost, and improve productivity are called Quality Improvement The process/strategy of Quality Improvement is called PDSA Cycle Plan Do Study Act The PDSA Cycle is The process/strategy of Quality Improvement The 4 components of Health Policy are Process Policy reform Policy environment Policy makers Process, Policy reform, Policy environment, and Policy makers are the 4 components of Health Policy What is 3-part "process" component of Health Policy? Formulation, Implementation, and Evaluation (FIE) Formulation, Implementation, and Evaluation (FIE) are The "process" component of Health Policy What is the "policy reform" component of Health Policy? Changes in programs and practices Changes in programs and practices in Health Policy is called Policy Reform What is the "policy environment" component of Health Policy? The arena the process takes place in (government, media, public) The arena the process takes place in (government, media, public) is what component of Health Policy? Policy environment What is the "policy makers" component of Health Policy? Key players and stake holders Screening Brief Intervention Referral Treatment What is the Tarasoff Principle Duty to warn victim of imminent danger of homicidal patients What is the Duty to warn victim of imminent danger of homicidal patients? Tarasoff Principle An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications (court case) Rennie vs. Klein Court Case What is the Rennie vs Klein Court Base? Pts have the right to refuse treatment and use an appeal process It is unconstitutional to commit a person involuntarily (for the longest time) who is not (imminently) dangerous to self or others. Which court case? Donalson vs. O'Connor Court Case What is the Donaldson vs. O'Connor court case? You cannot confine (commit a person involuntarily) who is not dangerous to self or others What are 4 key components of Strategic Therapy? Problem Focused, Symptoms focused Paradoxical directive/intervention (reverse psychology) Straight forward directive Reframe belief system The paradoxical directive, a technique to be used with caution, is used in which therapy? Strategic Which 3 techniques are used in Solution-Focused Therapy? Miracle Questions Exception-finding questions Scaling Questions Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? Solution-Focused Which therapy uses triangles/triangulation, an self-differentiation? Family Systems Therapy What are 3 characteristics of Family Systems Therapy ? Triangles/Triangulation Self-differentiation Genograms Ethnospecific If a patient is regularly taking Kava, what lab should you get? LFTs What is the key symptom in suspecting Stephen's Johnson Syndrome? Fever Which antipsychotic has the least weight gain? Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) Which 3 antipsychotic causes weight gain? Quetiapine (Seroquel) Olanzapine (Zyprexa) Clozapine (Clozaril) What is the first action to take with a patient who is gaining weight from an SGA? nonpharmacologic nutritional counseling (diet) exercise CBT When should clozapine be discontinued? ANC < 1,000 (even if asymptomatic) One of your patients receiving psychiatric medication develops an infection. What do you consider? Agranulocytosis What antipsychotic is antisuicidal in schizophrenia? Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? HCG If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? DC lithium What is one of the most important teaching points you should make in a patient taking lithium? Stay hydrated A patient with what medical condition is at risk for lithium toxicity? Cardiac failure (hyponatremia) What is the key indicator for NMS? Extreme muscle rigidity - Increased CPK Extreme muscle rigidity and increased CPK is the key indicator of NMS What is the key indicator of Serotonin Syndrome? Muscle jerks (myoclonic) Which 2 groups is it especially important to ask about SI at each visit? Adolescence Schizophrenics Why do children have a decreased placebo response with antidepressants? Few evidence-based studies What is the onset of schizophrenia in males? 18-25 What is the onset of schizophrenia in females? 25-35 What question should ask schizophrenic patients at each visit? SI What is the most likely diagnosis in a patient with homicidal ideation? Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? All structures decreased except ventricles Which class of agents should be avoided in patients with schizophrenia? Stimulants (increased DA) Which 3 structures in the brain are associated with aggressive and impulsive behavior? Prefrontal cortex Amygdala Hippocampus What is Assertive Community Treatment (ACT)? Form of rehabilitation post hospitalization for SMI Case management approach Patients with SMI who are discharged from the hospital should be referred to Assertive Community Treatment (ACT) Can patients receive Assertive Community Treatment (ACT) while in the hospital? No Which services can be provided in the home for SMI patients? Assertive Community Treatment (ACT) What is the best treatment program for SMI patients with poor medication adherence? Assertive Community Treatment (ACT) Social skills training in a schizophrenic patient is what type of prevention? Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients? Increased cognition Quality of Life Long-term health How do you convert oral Haldol to IM (depot form)? 20 x daily dose When converting oral Haldol to depo form, what the maximum dose should administer? >100 mg (administer weekly if necessary) What is a normal prolactin level in men? <20 What is a normal prolactin level in women? <25 What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? Decrease olanzapine dose What effect does tobacco have on CYP450? 1A2 inducer What class of drugs are primarily inhibitors? Antibiotics How does erythromycin and clarithromycin affect CYP240? Inhibitors What do you do if a patient on carbamazepine is given an inhibitor? Decrease CBZ dose (avoid aplastic anemia) If a depressed patient is receiving a drug that is associated with depression, what do you do? Increase dose of antidepressant Addiction is associated with what 2 neurotransmitters? Dopamine GABA What 7 signs/symptoms are associated with stimulant abuse? Insomnia Tremors Irritability, Mood swings. Agitation, Anxiety CV (increased HR/BP, palpitations) A patient who c/o pain after eating, bloating and fullness, what do you suspect? Delayed gastric emptying from anorexia What 3 signs/symptoms do you expect with delayed gastric emptying in anorexia? Pain after eating Bloating Abdominal fullness What 2 classes of medications delay gastric emptying? H2 antagonists: Famotidine (Pepcid) PPIs: Omeprazole (Prilosec) What 2 classes of medications interfere with the absorption of psychiatric medications and should be spaced apart by 2 hours? Antacids PPIs: Omeprazole (Prilosec), Pantoprazole (Protonix) What is a common side effect of SSRIs in the older population Anxiety What is a paradoxical effect of benzodiazepines? Increased anxiety (avoid in future) What is apotosis? Cell death/neuronal loss In DBT, diagnosis of borderline disorder requires activity? journaling/diary A patient with borderline personality disorder with symptoms of depressed mood and lability should be prescribed Valproic acid When should valproic acid be prescribed in a patient with borderline personality disorder? Depressed mood + lability A hospitalized patient with a reaction to a stressful event is most likely to have what diagnosis? Adjustment Disorder A child with a history of juvenile detention (e.g., fire setting, forced sex) is most likely to have what diagnosis? Conduct Disorder Is a child with ODD or Conduct Disorder more likely to need medication? Conduct Disorder If a child develops tics after beginning a stimulant, should he be diagnosed with Tourette's? No (tics caused by a substance is an exclusionary diagnosis) Are motor tics permanent? Not always What 3 neurotransmitters are involved with Tourette's? DNS What is factitious disorder imposed on another? Munchausen syndrome by proxy, caretakers make up or produce physical illnesses in the individual receiving care. Usually parent --> child What is required if you suspect a factitious disorder imposed on another (Munchausen syndrome)? Report to CPS Child abuse (duty to report) What is Factitious Disorder Faking illness to get medical attention or sympathy A patient who feigns illness to get sympathy or attention is most likely to have Factitious disorder A patient with factitious disorder is most likely to have what type of demographic? Unmarried healthcare worker What is malingering? Feigning illness for secondary gain ($) (not a psychiatric diagnosis) A patient who claims disability or worker's comp when there is no injury is most likely Malingering (not a psychiatric diagnosis) A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? Reactive Attachment Disorder A child who shows no emotion or is withdrawn may have what disorder? Reactive Attachment Disorder A disorder that presents like PTSD, but symptoms last less than a month is most likely to have Acute Stress Disorder When a patient presents with what 3 symptoms should you administer the Mood Disorder Questionnaire (MDQ)? Patient presents with irritability, depression, and lability What disorder resembles bipolar disorder in children (7 and 17 years)? Disruptive Mood Dysregulation Disorder (DMDD) A child with intense temper outbursts is most likely to have what DSM-5 diagnosis? Disruptive Mood Dysregulation Disorder (DMDD) What should assess initially in a child who presents with nightmares? If other family members have the same problem What are 2 key factors in the diagnosis of Autism Spectrum Disorder? Persistent deficits in social communication and social interaction across multiple settings A child with persistent deficits in social communication and social interaction across multiple settings is most likely to have what DSM-5 diagnosis? Autism A child that does not establish eye contact is likely to have autism spectrum disorder When is the only time you should give a benzodiazepine to a patient with delirium? Alcohol withdrawal A patient in alcohol withdrawal who develops delirium should be administered Benzodiazepine An older female has delirium and you suspect a UTI, what 2 labs should you order? UA C/S An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for Dementia What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? B12 Folic acid What is the initial treatment for a patient with dementia and psychosis? Nonpharmacologic treatment If a patient with dementia does not respond to nonpharmacologic treatment, what do you do? Administer SGA What type of dementia is HIV-related? Subcortical What are 3 early signs/symptoms of HIV-related dementia? Cognitive deficit Motor abnormalities (decreased coordination) Behavioral symptoms A patient who presents with a cognitive deficit, decreased coordination, and behavioral symptoms should be assessed for what type of dementia? HIV-related In a patient with suspected HIV-related dementia, what is your initial action? Obtain HIV test What is first-line pharmacologic treatment for a patient with HIV-related dementia? Antiretroviral treatment Lack of empathy Difficulty with impulse control and emotions A patient who presents with cognitive dysfunction (decision making), lack of empathy, and difficulty with impulse control and emotions is most likely to have damage in what brain structure? Anterior cingulate A patient with damage to the cerebellum will demonstrate what sign? Lack of balance A patient who has a lack of balance is most likely to have damage to what structure in the brain? Cerebellum What condition may cause pica (eating things that are not food - paint chips)? Lead poisoning What 5 neurotransmitters are associated with mood disorders? Dopamine Norepinephrine Serotonin GABA Glutamate What do do yo do when an infant is about to die? Give him to his parents to grieve What 2 activities should be encouraged with grieving patients? Family support Support groups (don't give prescriptive advice) What are 5 risk factors for osteoporosis? Smoking Caffeine Low calcium/vitamin D in diet Decreased weight Lack of weight bearing exercises Smoking, Caffeine, Low calcium/vitamin D in diet, Decreased weight, and Lack of weight bearing exercises are risk factors for Osteoporosis Is Interpersonal Therapy offered individually as well as in group therapy? Yes If a patient is reluctant to participate in group therapy, what do you do? Continue group therapy Start individual therapy Which is more effective - cognitive therapy or CBT? CBT What are 5 techniques used in behavioral therapy? Problem-solving Skills training Exposure therapy Role-playing/modeling Relaxation Problem-solving, Skills training, Exposure therapy, Roleplaying/modeling, and relaxation are techniques used in Behavioral Therapy What are 2 common techniques used in CBT? Cognitive restructuring Meditation is a form of Muscle relaxation What 4 positive effects does physical activity have on children? Increased body image Increased resilience Improved relationships Decreased social anxiety How can a child's body image, resilience, relationships, and social anxiety be improved? Physical activity When may a closed-ended question (yes/no) be necessary rather than an opened-ended question? Children (when a narrative cannot be constructed) If a child does not respond or open or closed-ended questions, what to you do? talk to parents What therapeutic factor does open-ended questions instill? empathy If only the wife shows up for a couple appointment, what do you do? Reschedule the appointment A mother reports that her child was sodomized. What 2 things do you do? Contact CPS Crisis therapy A mother reports her 5-yo was raped by his 16 yo brother. What 2 things do you do? crisis therapy separate brothers What lab do you draw in a patient with rheumatoid arthritis ESR When is an ESR indicated? Patient with rheumatoid arthritis What does PICO stand for? P- Patient population of interest I - Intervention of interest C - Comparison of interest O - Outcome How do you provide evidenced-based care? Have access to current journals A baby with a shrill cry is likely to have Increased intracranial pressure A sign of increased intracranial pressure in a baby is shrill cry What do you tell a mother when she reports her preschool child is playing with his genitals? That is normal between 3-6 yrs old (Phallic stage) What do you tell an adolescent who is concerned about nipple swelling and tenderness and breast enlargement? This is normal between 9-16 yo. It will disappear within 6 mo. How do you treat decreased sexual drive in a older female patient? Folic acid B12 Folic acid deficiency creates what type of anemia? Macrocytic With normocytic, macrocytic anemia, what 3 labs do you obtain? B12, folic acid, Fe B12 deficiency creates what type of anemia? Macrocytic What deficiency is associated with microcytic anemia? Iron An iron deficiency causes what type of anemia? Microcytic Acute or chronic blood loss (GI bleeding, heaving menses) can cause what type of anemia? Normocytic Normocytic anemia is due to Chronic or acute blood loss (GI bleeding, menses) What is the BMI in a patient with Bulimia Nervosa? Normal When vital signs are not normal in a thin women, you suspect Anorexia nervosa You see a patient with suspected anorexia nervosa. What do you do? Refer out for medical evaluation If a patient with anorexia nervosa refuses to see a PCP, what do you do? Contact CPS If AN patient is medically unstable and parents refuse hospital treatment, what do you do? contact CPS What 2 conditions is acupuncture used? Pain Depression What alternative medicine treatment is used with pain and depression? Acupuncture Habeas Corpus Act Protects a patient from unlawful hospitalization (able to leave AMA) What act prevents a patient from unlawful hospitalization (can leave AMA)? Habeus corpus (usually max of 28 days) A patient presents with paresthesia, fatigue and asymmetric body movement of extremities. What do you suspect and what do you do? Disseminated Encephalomyelitis Neuro exam What is Disseminated Encephalomyelitis and what are 3 symptoms? Autoimmune viral infection - children Paresthesia What does a black box warning provide? Benefits and risks A patient calls because he read on the internet about a BBW on his medication. What do you do? You don't need to discontinue drug. Research benefits and risks What are 2 things you should do when you prescribe off-label? Document Provide full disclosure (risks/benefits) When you prescribe trazodone to a male patient, what should you do? Warn about priapism and document What are 3 risk factors for Sleep Apnea? Smoking Increase weight/obesity DM Smoking, increased weight/obesity, and DM are risk factors for what disorder? Sleep Apnea What is tolerance? Decreased effect with continuous use Decreased effect with continuous use results in Tolerance What is the goal or Reflective Practice? Improve practice What is Reflective Practice? Providing debriefing techniques, feedback to staff, and strategies to learn from experiences Providing debriefing techniques, feedback to staff and strategies to learn from experiences is called Reflective Practice If a patient has mild symptoms on the COWs, what should you do? Give clonidine or a muscle relaxant When should you administer clonidine or a muscle relaxant to a patient withdrawing from opiates? mild symptoms (8 or higher) If a patient scores 8 or more on the COWS during opiate withdrawal, what should you do? Administer clonidine or a muscle relaxant If a patient has moderate symptoms on the COWS what should you do? Administer buprenorphine/naloxone (Suboxone) When should you administer buprenorphine/naloxone (Suboxone) in a patient withdrawing from opiates? Moderate symptoms (13 or higher) If a patient scores 13 or higher on the COWS scale during opiate withdrawal, what do you do? Administer buprenorphine/naloxone (Suboxone) Why should methadone not be used to treat opiate withdrawal? Arrhythmias Instillation of Hope Universality Altruism Increased development of socialization skills Imitative behaviors Interpersonal learning Group cohesiveness Catharsis Existential factors Corrective refocusing Instillation of Hope, Universality, Altruism, Increased development of socialization skills, Imitative behaviors, Interpersonal learning, Group cohesiveness, Catharsis, Existential factors, and Corrective refocusing are Therapeutic Factors which differentiate group therapy from individual therapy Experiencing optimism through observing the improvement of others in the group is which of Yalom's therapeutic factors? Instillation of Hope Sharing experiences/feelings in group clients realize they are not alone is which of Yalom's therapeutic factors? Universality Learning to give to others is which of Yalom's therapeutic factors? Altruism The "natural laboratory" is which of Yalom's therapeutic factors? Increased development of social skills Group members modeling their behavior after other members of group/therapist is which of Yalom's therapeutic factors? Imitative behavior Interacting with others to increase adaptive interpersonal relationships is which of Yalom's therapeutic factors? Interpersonal learning Developing a sense of belonging in the group is which of Yalom's therapeutic factors? Group cohesiveness Group members dealing with the meaning of their existence is which of Yalom's therapeutic factors? Existential factors Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic is which of Yalom's Therapeutic Factors? Corrective refocusing Openly expressing their feelings which were previously suppressed is which of Yalom's Therapeutic Factors? Catharsis What is the key component of Appreciate Inquiry? Focusing on strength of the group Focusing on the strength of the group is key to what organizational change strategy? Appreciative Inquiry Who determines the Scope of Practice? State legislature (BON) (varies state to state) Who determines the Standard of Practice? ANA (doesn't change)